INNOBLOG

In the most recent New England Journal of Medicine, a study illustrates the vast differences in quality of care provided by highly experienced gastroenterolists in a single Illinois practice. The study examines detection rates of polyps during colonoscopies, and reveals that the doctor who took the longest time looking for polyps found them TEN TIMES more frequently than the doctor who took the least amount of time. This is disturbing for patients, who have no idea if the right amount of time is being expended. Similarly, insurers do not distinguish in their payments between those physicians who take the recommended six minutes vs. those who are more speedy. And it makes no difference to equipment suppliers -- or does it? It is only natural to expect physicians, who are reimbursed based on the number of procedures they perform, to try to work fast. It's just human nature, as is the potential for mistakes. Insisting the doctors take the full six minutes is difficult to enforce, and may not lead to more care being taken in the procedure. Rather, there is great potential for suppliers to create new, less error-prone means of polyp detection. It would be a bonus if these tests did not require a specialist physician to administer. And indeed we see that happening. New, accurate, non-invasive tests for bloody stool are being marketed by firms such as Helena Laboratories and Biomerica. These tests lack the precision of a full colonoscopy, but can screen patients with likely risk factors so that their colonoscopies are performed with much greater rigor. Given that only 2-15% of patients undergoing colonoscopy actually have colon cancer, there is also significant potential to reduce healthcare costs by concentrating these procedures on the right patients. The broader principle at work is that firms should spend less energy perfecting tests that require great human skill -- and attention -- to interpret, and more energy on creating screening exams and black-and-white diagnoses that allow less specialized providers to deliver the care in a higher-quality and lower-cost fashion. Patients whose conditions are more complex can then be seen by specialized providers. Oftentimes these innovations actually increase utilization of specialized providers -- the impact of portable ultrasound on radiologists comes to mind -- and they create wins for the patient, insurer, and supplier.